Executive Editor: Steve Krikler

Authors: Renato Fricker, Jesse Jupiter, Matej Kastelec

Distal forearm Partial articular fracture of the radius, involving the volar rim

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Glossary

General considerations

Partial articular fractures of the radius demand accurate reduction since they involve the articular surface.

In fractures involving the palmar rim, the wrist is frequently very unstable, so they usually require stabilization.

Any patient who has had a fall on the outstretched hand may have sustained an intercarpal ligament injury; these may easily be missed on initial clinical assessment.

Note: CT scans may be helpful for treatment decisions.

Nonoperative treatment - Cast
Main indication Skill Equipment
Low-demand patient; surgery contraindicated Basic surgical experience, no specialized skills Basic equipment only

Indications

  • Low-demand patient
  • Patient not fit for surgery
  • Poor state of soft tissues

Contraindications

  • Displacement
  • Radiocarpal subluxation
  • Open fractures

Disadvantages

  • Risk of further displacement
  • Risk of radiocarpal subluxation
Joint-spanning external fixation (temporary)
Main indication Skill Equipment
Temporary stabilization in polytrauma, unfit patient, insufficient hold in a cast, patient not suitable for ORIF Some specialized surgical experience Simple surgical and imaging resources

As these are articular injuries, with a high risk of radiocarpal subluxation, they should normally be fixed. 

Indications

  • Temporary stabilization in polytrauma
  • Significant local skin compromise
  • Poor medical condition of patient
  • Congruous reduction of the dislocation possible
  • No more than three sizeable dorsal fracture fragments
  • Anatomical reduction

Contraindications

  • Associated intercarpal ligament injury
  • Osteoporosis
  • Irreducible fracture

Advantages

  • Less complex to perform than plate fixation
  • Can be combined with percutaneous pinning and / or open reduction and fixation of small dorsal / palmar rim fragments and ligament repair
  • Enhanced stability
  • Improved articular congruity

Disadvantages

  • Risk of radial sensory nerve injury
  • Risk of injury to extensor tendon
  • Risk of metacarpal fracture
  • Risk of joint stiffness, especially with over-distraction
  • Risk of pin-track infection
  • Danger of overdistraction leading to complex regional pain syndrome type I (CRPS 1)
  • Prolonged external fixation can lead to joint stiffness
  • Risk of redisplacement after removal
ORIF - Palmar plate
Main indication Skill Equipment
Almost all Goyrand-Smith II fractures Highly experienced and skilled surgeon Full specialized surgical and imaging resources

As these are articular injuries, with a high risk of radiocarpal subluxation, they should normally be fixed. 

Contraindications

  • Patient not fit for surgery
  • Poor state of soft tissues

Advantages

  • Used in buttress mode
  • Stability in comminuted fractures
  • Articular congruity
  • Early motion

Disadvantages

  • Risk of soft tissue irritation
  • Complex later implant removal
*Skill
Basic surgical experience, no specialized skills Basic surgical experience, no specialized skills
Some specialized surgical experience Some specialized surgical experience
Highly experienced and skilled surgeon Highly experienced and skilled surgeon
*Equipment
Basic equipment only Basic equipment only
Simple surgical and imaging resources Simple surgical and imaging resources
Full specialized surgical and imaging resources Full specialized surgical and imaging resources